1. Field of the Invention
This invention relates to a novel nasogastric introducer tube and catheter for direct intubation of the duodenum or jejunum.
2. Prior Art
Failure of gastrointestinal functions may require intubation of the duodenum to facilitate feeding into and/or aspiration of the small bowel of the patient. Prior art intubation devices include both percutaneous endoscopically placed catheters and nasogastric tubes which may require endoscopic placement. An example of an endoscopically placed nasogastric tube is disclosed by Kim in U.S. Pat. No. 4,631,054. Kim's catheter comprises a flexible nasogastric tube with a mercury-filled bag circumferentially mounted near the distal tip of the catheter. The placement of Kim's catheter requires intubation with a gastroduodenoscope through which a flexible guidewire is introduced. The guidewire is advanced into the duodenum and the gastroduodenoscope removed. The catheter is then marked at the appropriate length and inserted through the nose over the guidewire and advanced to the mark. The guidewire is then removed leaving the distal tip of the catheter positioned within the duodenum. While Kim's method and catheter do not require fluoroscopic placement, it does require specialized endoscopic equipment for appropriate placement.
Nelson, Jr., in U.S. Pat. No. 4,368,739 discloses a long intestinal catheter for placement during open surgery. The catheter has a pair of inflatable balloons, the first one at its downstream end and the other a short distance upstream from the first one. The two balloons are inflated when the catheter approaches the duodenum to facilitate the manually directed passage into and through the duodenum. The catheter is then advanced through the duodenum and small intestine during surgery by manual manipulation of inflated balloons through an incision in the abdomen.
Moss, in U.S. Pat. Nos. 4,543,089 and 4,642,092, describes a gastric catheter which is used to aspirate gas and feed patients. The tube is placed percutaneously into the stomach by insertion of the tube through the abdominal wall by means of a laparoscopic trocar.
Notwithstanding the availability of the foregoing prior art devices, the success rate of getting nasogastric tubes through the pylorus and into the duodenum are as low as 50%. Fluoroscopic placement has improved the success rate of placement of duodenal tubes, but the process of passing a long tube into the duodenum through the pylorus still demands improvement especially for the seriously ill patient who cannot be conveniently or comfortably moved to radiology facility.
The use of prior art nasogastric tubes for feeding may result in aspiration pneumonia. This condition results when the integrity of the seal between the esophagus and the stomach is breached as, for example, by a stomach feeding tube passing therethrough. When an intubated patient is positioned laterally, the gastric contents may flow back along the tube up the esophagus where it may enter the trachea and be aspirated into the lung. This condition is particularly prevalent in the elderly. It is, therefore, desirable to provide a duodenal feeding tube which reduces the incidence of aspiration pneumonia and is easily placed without the need for surgery or fluoroscopic or endoscopic placement.